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Scleritis in Emergency Medicine Workup

  • Author: Theodore J Gaeta, DO, MPH, FACEP; Chief Editor: Robert E O'Connor, MD, MPH  more...
 
Updated: Dec 29, 2015
 

Laboratory Studies

Depending on the clinical suspicion, laboratory studies may be warranted. Laboratory tests include, but are not limited to, the following:

  • Complete blood count (CBC) and electrolytes
  • Erythrocyte sedimentation rate (ESR)
  • FTA-ABS (RPR)
  • Uric acid
  • Rheumatoid factor
  • Antinuclear antibody (ANA)

The ED is the ideal location to initiate evaluation for collagen vascular disease, infection (conjunctival cultures), and immunocompetency. If scleritis is suspected, the emergency physician will contact an ophthalmologist. This would be a good opportunity to establish an evaluation and intervention plan. Getting the laboratory studies in the ED will save time for the patient and practitioners.

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Imaging Studies

See the list below:

  • B-scan ultrasonography may assist in detecting posterior scleritis. MRI or CT scans may play a role, but they should be ordered in consultation with an ophthalmologist.
  • Chest radiography may be indicated to look for underlying pulmonary involvement arising from systemic disease.
  • Imaging of sacroiliac joints is prudent when ankylosing spondylitis is suspected.
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Other Tests

Instillation of phenylephrine, a mydriatic vasoconstrictor, helps differentiate deep scleral episcleral blood vessel involvement from superficial involvement; superficial vessels blanch following application of phenylephrine, while deeper vessels remain unaffected.

Seidel test helps detect possible global perforation. Apply a moistened fluorescein strip over the entire surface of the eye while viewing under a slit lamp. If perforation exists, the fluorescein dye becomes diluted by the aqueous humor, appearing as a green dilute stream within the dark, concentrated, orange dye. Alternatively a Wood lamp may be used if a slit lamp is not available.

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Procedures

Apply an eye shield when scleral thinning or global perforation is suspected. Ensure that the eye guard does not contact the eyelid or globe. Apply tape from the forehead to zygoma. In the absence of an eye shield, use a paper or polystyrene cup, provided it is large enough to cover the eye without placing undue pressure on the globe.

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Contributor Information and Disclosures
Author

Theodore J Gaeta, DO, MPH, FACEP Clinical Associate Professor, Department of Emergency Medicine, Weill Cornell Medical College; Vice Chairman and Program Director of Emergency Medicine Residency Program, Department of Emergency Medicine, New York Methodist Hospital; Academic Chair, Adjunct Professor, Department of Emergency Medicine, St George's University School of Medicine

Theodore J Gaeta, DO, MPH, FACEP is a member of the following medical societies: American College of Emergency Physicians, New York Academy of Medicine, Society for Academic Emergency Medicine, Council of Emergency Medicine Residency Directors, Clerkship Directors in Emergency Medicine, Alliance for Clinical Education

Disclosure: Nothing to disclose.

Coauthor(s)

Diana Valcich, MD Attending Physician, Department of Emergency Medicine, North Shore LIJ Hospital System

Diana Valcich, MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Gino A Farina, MD, FACEP, FAAEM Professor of Emergency Medicine, Hofstra North Shore-LIJ School of Medicine at Hofstra University; Program Director, Department of Emergency Medicine, Long Island Jewish Medical Center

Gino A Farina, MD, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Robert E O'Connor, MD, MPH Professor and Chair, Department of Emergency Medicine, University of Virginia Health System

Robert E O'Connor, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Association for Physician Leadership, American Heart Association, Medical Society of Delaware, Society for Academic Emergency Medicine, Wilderness Medical Society, American Medical Association, National Association of EMS Physicians

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors, Jerome FX Naradzay, MD, Loice Swisher, MD, and Jonathan Adler, MD, to the development and writing of this article.

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